Musculoskeletal disorders (MSDs) affect about one out of three adults in the U.S., are the leading cause of adult disability, and have total costs exceeding $100 billion/year. For most of the past two decades, treatment of arthritis and osteoporosis remained largely stagnant. Since 1998, over 15 new treatments have been FDA approved for MSDs, including novel biological response modifiers. Despite significant efficacy in clinical trials, questions and concerns persist about the safety, comparative effectiveness, and costs (biologics > $10,000 annually/patient) of some of these new agents. During its six years of past AHRQ funding, the UAB CERTs conducted over 30 projects creating new knowledge and products, disseminating research and education findings, and improving public health. Our main objective of this new application is to seize the momentum of our past success to better promote the safe and effective use of MSD therapeutics. Given the rising burden of MSD in an aging society and the rapidly advancing efficacious yet costly therapeutic options with risk of serious adverse events, this objective is both timely and very important. The specific aims of the proposed Deep South Musculoskeletal (DSM) CERTs are to: 1) Improve safety and effectiveness of MSD therapeutics through four demonstration projects that effectively build on our major research domains of safety and effectiveness evidence generation and translating research into practice: (a) The Alabama NSAID Patient Safety Study, Phase II: Reducing Disparities in Risk Assessment and Communication; (b) Improving Osteoporosis Care for High-Risk Home Health Patients by a High-intensity Intervention; (c) Defining Serious Adverse Events from Biologic Therapies; and (d) Osteonecrosis of the Jaw: An Emerging Threat for Bisphosphonate Users; 2) Educate health care practitioners, insurers, and policy makers while broadening the public health impact of our research and educational portfolio about musculoskeletal therapeutics; and 3) In cooperation with AHRQ, other CERTs, and our network of partners, and building upon the themes, experience, and investigator talent pool of our CERTs, develop seed projects into full proposals that will be submitted to external funding agencies for peer review. We have expanded our group of experienced senior and talented junior investigators, our dedicated staff, and a rich network of regional and national partners. Through our Administrative Unit, a Methods Core containing Communications, Economics and Biostatistical Components, and an Education and Dissemination Core we provide the necessary infrastructure, a clear organizational plan, and proven research/educational expertise to successful undertake this multi-disciplinary program. Our subtheme of risk communication to patients and/or healthcare providers runs through all four demonstration projects, the seed projects, and the Cores. In recognition of the special relevance of eliminating racial/ethnic disparities in MSD therapeutics, we have chosen the name DSM CERTs, reflecting on our region's past, and demonstrating our commitment to further improve regional and national MSD health care quality. [unreadable] [unreadable] [unreadable] [unreadable]